What EEG findings are characteristic of action myoclonus?

Updated: Oct 09, 2019
  • Author: Eli S Neiman, DO, FACN; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Action myoclonus consists of arrhythmic muscular jerking induced by voluntary movement. It can be made worse by attempts at precise or coordinated movement (ie, intention myoclonus) and may be elicited by sensory stimuli. The effective stimulus for action myoclonus is thought to be feedback from muscle afferents, although it may be related to activity in the motor cortex relayed to the reticular formation preceding or coinciding with voluntary movement.

The condition usually is associated with diffuse neuronal diseases, such as posthypoxic encephalopathy, uremia, and the various forms of peripheral neuroepithelioma, although action myoclonus may be limited to one limb in some cases of focal cerebral damage. It is caused by hyperexcitability of the sensorimotor cortex (ie, cortical reflex myoclonus) or reticular formation (ie, reticular reflex myoclonus), or both. Autopsied cases have failed to reveal a clear pathology. Theories include loss of inhibitory mechanisms involving serotonin and possibly gamma-aminobutyric acid (GABA) transmitters.

Myoclonus may be seen in degenerative disorders of the nervous system. It may be associated with tonic-clonic seizures or dementia. Myoclonus has been described in cases with Lafora inclusion bodies and cerebral storage diseases, as well as system degenerations: cerebellodentatorubral, pyramidal, extrapyramidal, optic, auditory, posterior columns and gracile and cuneate nuclei, spinocerebellar pathways, motor neurons of cranial nerves and anterior horns, and muscle fibers.

Action myoclonus usually responds to sodium valproate or clonazepam, and some patients with posthypoxic action myoclonus may improve with serotonin precursors.


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